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The Positive Outlook Study: A Randomised Controlled Trial Evaluating Online Self- Management for HIV Positive Gay Men
Tanya Millard1§, Paul A Agius2, 3, Karalyn McDonald1, 4, 5, Sean Slavin6, Sonya Girdler7 & Julian H Elliott1,2,8.
1Department of Infectious Diseases, Monash University, Melbourne, Australia; 2Centre for Population Health, Burnet Institute, Melbourne, Australia; 3 Judith Lumley Centre, La Trobe University, Melbourne, Australia; 4Jean Hailes Research Unit, Monash University; 5Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia; 6Centre for Social Research in Health, University of New South Wales, Sydney, Australia; 7School of Occupational Therapy and Social Work, Curtin University, Perth, Australia; 8Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia.
Background
HIV now a chronic condition
Psychosocial issues prominent
Self-management
Client central in managing physical, social, emotional aspects
Widely used in chronic disease management
Effective at improving health outcomes
Effectiveness for PWHIV has not been well established
Barriers to existing programs for PWHIV: time; location;
transport; stigma; desire for anonymity; lack of association with community organisations
Background
Online intervention delivery - improved access and reduced associated costs
Beneficial for populations who are diverse and difficult to engage in existing services
Increased number of HIV-specific websites; online delivery increasingly employed in HIV programming
Lack of empirical evidence regarding efficacy
The Positive Outlook Program
Based on self-efficacy theory; utilised a self-management approach
The intervention encouraged participants to take responsibility for the self-management of their condition including managing physical, social and emotional aspects of health and making behavioural changes
Full intervention description in protocol paper*
*Millard T, Elliott J, Slavin S, McDonald K, Rowell S, Girdler S: The positive outlook study- a randomised controlled trial evaluating the effectiveness of an online self-management program targeting psychosocial issues for men living with HIV: a study protocol. BMC Public Health 2014, 14:106.
The Positive Outlook Program
Enhance participants’ (MSM) skills, confidence and abilities to manage the psychosocial aspects of HIV in their daily lives.
Closed group
7 week program, ~90 minutes per week
Information modules (10-15 web pages); goal setting and action planning activities; discussion boards; weekly live chat
Peer-facilitated
Participants used pseudonyms
• Orientation
• Maintaining a healthy lifestyle- setting health related goals etc Week 1
• HIV and You: the emotional impact of HIV; and maintaining social connectedness
Week 2
• Talking about HIV: Disclosure to friends, family and acquaintances.
Week 3
• HIV You and Others (Part 1): HIV and intimate relationships; safe sex basics:
and sexually transmitted infections.
Week 4
• HIV You and Others (Part 2): Disclosure to intimate partners; seeking new relationships; and dealing with rejection.
Week 5
• HIV You and Others (Part 3): Managing HIV within intimate relationships and negotiating risk reduction strategies.
Week 6
• Wrap up: Reflect and review Week 7
Methods
Randomised Controlled Trial
Research Question: What is the effectiveness of the Positive Outlook program on improving general health and HIV-specific outcomes compared with usual care only?
Methods
Inclusion Criteria
HIV positive men over 18 years living in Australia
Self-identified as gay or MSM
Ability to read and write in English
Self-reported access to a computer and the Internet for >90 minutes per week for seven weeks
Adequate computer skills
National recruitment
Outcome Measures
Three time-points: (1) after randomisation, (2) at conclusion of intervention and (3) at 12 week follow-up.
Primary Outcomes:
1. HIV-related quality of life (PROQOL-HIV) 2. Outcomes of health education (heiQ) 3. Positive Outlook Self-Efficacy Scale (POSE)
Secondary Outcomes:
Quality of life (SF12)
Duke Social Support Index (DSSI)
Depression, Anxiety and Stress Scale (DASS21)
Mental Adjustment to HIV Scale (MAH)
General Self Efficacy Scale (GSE)
Flow of Participants
Registered interest (n= 227)
Completed baseline questionnaire & randomized (n= 132) Registered interest (n= 227)
Completed baseline questionnaire & randomized (n= 132)
Statistical Analysis
Contingency table analyses comparing baseline characteristics
Maximum likelihood marginal-linear modelling on repeated measures data
Results
Participant characteristics
Median age 43
72% born in Australia
67% single; 72% tertiary qualification; 40% live alone
60% full-time employment; 15% part-time; 25%
unemployed
Median length of diagnosis 6 years
80% on ART
3 PROQOL-HIV
† robust standard errors specified in modelling
^ p-values are Bonferonni adjusted
PHS – Physical health and symptoms; BC – Body change; SR – Social relationships; IR – Intimate relationships; ST – Stigma; ED – Emotional distress; HC – Health concerns; TI – Treatment impact;
HeiQ
† robust standard errors specified in modelling
^ p-values are Bonferonni adjusted
HDA – Health directed activity; PAE – Positive and active engagement in life; ED – Emotional distress; SM – Self monitoring and insight; CAA – Constructive attitudes and approaches; STA – Skill and technique acquisition; SIS – Social integration and support; HSN – Health service navigation.
Positive Outlook Self-Efficacy Scale (POSE)
† robust standard errors specified in modelling
^ p-values are Bonferonni adjusted
Discussion/ Conclusions
Significant improvements in quality of life, self-management skills and domain specific self-efficacy for gay men with HIV
Consistent improvements in emotional distress and social relationships/participation
Pattern of diminishing effect
Participant engagement
Duration
Further research needed to explore long-term effectiveness
Discussion/ Conclusions
Limitations: sample size; high loss to follow-up; short follow-up
Innovative programs are required to address pervasive issues
Online delivery: feasible, effective, well-accepted and anonymous
Acknowledgements
Sexual Health and Blood Borne Virus Program; Australian Postgraduate Award
Watson Browne Bequest; NAPWHA
NAPWHA; VAC; Living Positive Victoria; ACON; WAAC
Recruiting partners
Participants
Facilitators